United States Health Information Knowledgebase


Delay Reason Code

Name:Delay Reason Code
Definition:Code to specify the reason that submission of the transactions has been delayed.
Type:Data Element
Registration Authority:National Council for Prescription Drug Programs
Source:National Council for Prescription Drug Programs
Values for: Delay Reason Code
Value Value Meaning
1 Proof of eligibility unknown or unavailable - Transaction delayed because identification card or verification transaction not available, or patient enrollment in benefit plan not complete at the time of service.
2 Litigation - Transaction delayed because litigation to determine liability for medical expenditures was unresolved at the time of service.
3 Authorization delays - Transaction delayed because the review process for authorization of the service was not completed/finalized at the time of service.
4 Delay in certifying provider- Transaction delayed because the provider certification for participation with the plan was not completed/finalized at the time of service.
5 Delay in supplying billing forms- Transaction delayed because specified billing form was not available at the time of service.
6 Delay in delivery of custom-made appliances - Transaction delayed because custom-fabricated appliance was not ready for delivery at the time related services/supplies were provided.
7 Third party processing delay- Transaction delayed because payment decision of third party payer(s) was not complete/received at the time of service.
8 Delay in eligibility determination- Transaction delayed because patient enrollment in benefit plan not complete at the time of service; or subsequent determination made enrollment retroactive to or prior to the date of service.
9 Original claims rejected or denied due to a reason unrelated to the billing limitation rules- Transaction delayed for correction of inadequacies or errors on previous, timely submitted claims.
10 Administration delay in the prior approval process - Transaction delayed because the authorizing entity was unable to complete and/or provide the authorization prior to the time of service.
11 Other - Does not fit within any of the other delay reason codes
12 Received late with no exceptions
13 Substantial damage by fire, etc to provider records -Transaction delayed because damaged records of services had to be reconstructed in order to complete the transaction
14 Theft, sabotage/other willful acts by employee- Transaction delayed because of employee misconduct.
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